Preliminary Questionnaire

Preliminary Questionnaire
Today's Date
FAMILY INFORMATION
Marital Status*
Spouse's Information
Dependent's Name(s) & Age(s) ex: John (10)
Property*
Investments*
Retirement*
Business Assets
Insurance
Disability Insurance
Does your Insurance continue to fill a need?

YesNoI Don't Know
Do you work closely with an insurance agent?

YesNo
Liabilities*
Explain Personal Loan or Other Liabilities:
Living Expenses (not including above liabilities)*
Income*
Current Estate Plan*
Do you have an Estate Planning Attorney?*

YesNo
Is your Attorney a key decision maker for you?*

YesNo
Would you like us to recommend someone?*

YesNo
Is your CPA a key decision maker for you?*

YesNo
Do you feel you have achieved financial security?*

YesNo
How would you like to pass your estate?*
Do you have any potential inheritance?*

YesNo
If yes, please explain:
Do you plan to leave any portion of your estate to charity?*

YesNo
Do you need to make any special financial provisions for any member of your family?*

YesNo
If yes, who?
Are you willing to invest effort/money, if plan serves to reduce /eliminate tax?*

YesNo
What is your Risk Tolerance?
0 = Conservative, 50 = Moderate, 100 = Aggressive
What is your primary reason for investing?
What are you looking for in a financial advisor?
When deciding how to invest your money, which do you care about more?
The global stock market is often volatile. If your entire investment portfolio lost 10% of its value in a month during a market decline, what would you do?
When I invest money, I am:
1. If you own a home, do you have more than 30% equity?*
2. Do you plan to work during retirement?*
3. From an original investment of $150,000, your portfolio is now worth $250,000 suddenly declines by $37,500 or 15%, which best describes your response?*
4. Your portfolio, from previous question, is now worth $210,250 suddenly declines by $21,025 or 10%, which best describes your response?*
5. Have you invested in Equities?*
6. Have you invested in Fixed Incomes?*
7. Have you invested in Mutual Funds?*
8. Have you invested in Options, Futures or Derivatives?*
9. How would you describe your level of investment knowledge?*
10. How much investment experience do you have?*
11. Do you currently need to withdraw from your investments to provide income?*
12. How soon do you expect to withdraw from these assets to provide retirement income?*
Configurable list*
Thank you for completing this questionnaire.

If you have not yet scheduled an appointment, someone from our office will contact you, upon receipt of your questionnaire. We offer appointments form 9am - 5pm, M-F.

Please indicate your appointment preferences below:
MondayTuesdayWednesdayThursdayFriday
Earliest AppointmentMorningLunch HourMid AfternoonLatest AppointmentAnytime
We look forward to talking with you soon.

Should you have questions or concerns, feel free to give us a call.

If you have account statements, a budget, or other documents you wish to review with the advisor please email it 2 days prior to your meeting to jkulikowski@colonialtrust.com
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